Sometimes Amazing Things Happen

Heartbreak and Hope on the Bellevue Hospital Psychiatric Prison Ward

Elizabeth Ford

• Publisher: Regan Arts.
• Year: 2017
• Print ISBN: 9781941393437
• eBook ISBN: 9781942872306
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

From the Executive Director of Mental Health for Correctional Services in New York City, comes a revelatory and deeply compassionate memoir that takes readers inside Bellevue, and brings to life the world—the system, the staff, and the haunting cases—that shaped one young psychiatrist as she learned how to doctor and how to love. Elizabeth Ford went through medical school unsure of where she belonged. It wasn't until she did her psychiatry rotation that she found her calling—to care for one of the most vulnerable populations of mentally ill people, the inmates of New York's jails, including Rikers Island, who are so sick that they are sent to the Bellevue Hospital Prison Ward for care. These men were broken, unloved, without resources or support, and very ill. They could be violent, unpredictable, but they could also be funny and tender and needy. Mostly, they were human and they awakened in Ford a boundless compassion. Her patients made her a great doctor and a better person and, as she treated these men, she learned about doctoring, about nurturing, about parenting, and about love. While Ford was a psychiatrist at Bellevue she becomes a wife and a mother. In her book she shares her struggles to balance her life and her work, to care for her children and her patients, and to maintain the empathy that is essential to her practice—all in the face of a jaded institution, an exhausting workload, and the deeply emotionally taxing nature of her work. Ford brings humor, grace, and humanity to the lives of the patients in her care and in beautifully rendered prose illuminates the inner workings (and failings) of our mental health system, our justice system, and the prison system.

1

THE BODY BAG

At first, I don’t realize that the rusty, unmarked metal gate on the corner of Twenty-sixth Street and First Avenue is the entryway to Bellevue, which looms over the East River on one side and the city’s Poison Control Center on the other. Maybe the steady stream of people—amped-up, white-coated surgeons in scrubs, weary caregivers pushing invalids in wheelchairs, stumbling men who smell like alcohol and urine—should clue me in.

Since 1736, New York City has funded and supported Bellevue Hospital’s mission of caring for anyone who walks in the door. It is the oldest public hospital in the country. Originally called a “Publick Workhouse and House of Correction,” the modern-day hospital still treats patients who are mostly poor, uninsured, and homeless. Many are undocumented immigrants who speak no English. Some are under arrest. On the top floors sit the most famous psychiatric wards in the world. I know I am going to get to them someday, but first I have to learn to be a doctor.

Inside the gate, there is a decrepit garden with dying plants and dried-out fountains. A few weathered and lonely benches are scattered around. Perhaps this had once been a place of peace where you could quietly sit with a loved one, but now it is mostly a meet-up for drug dealers and their clients—and me. During the six months I spend working as an intern in medicine and neurology, I eat lunch on those benches, occasionally chatting with the addicts.

On my first day as a psychiatry intern, I happily join the rush of doctors and patients flowing into Bellevue. My fancy white coat with “NYU School of Medicine” stitched in purple cursive over the breast pocket is back at my apartment, hanging in a closet. Instead, I’m wearing my version of a fierce outfit—knee-high black boots with heels that bring me close to six feet tall, black tights, a short black skirt, a black sweater, and a thrift-store leather jacket that was a hand-me-up from my younger brother. The only clue that I’m a doctor is the stethoscope wrapped around my messenger bag. I am starting in the psychiatric emergency room to learn all about schizophrenia, antipsychotic medication, and how to commit someone to a hospital against his will.

Four narrow doors funnel people from the garden into a cavernous foyer with a set of brightly painted murals called “Materials for Relaxation,” created in 1941 and newly restored. I push through the door on the far right to circumvent the bottleneck of people streaming into the “F” link, the central thoroughfare that leads from one end of the hospital complex to the other. I swerve to avoid a young woman pushing a stroller and pulling her crying toddler, only to bump into an elderly, inebriated black man stumbling over stained and torn pants that drag on the floor. The masses of people around us merely shift their path.

“I’m so sorry,” I say, reaching to help steady the man. He grumbles incoherently and moves on.

The walls in the massive “F” link hallway are dull and white, decorated only by a handful of posters advertising insurance plans for low-income families and an upcoming Fourth of July garden picnic for the Bellevue staff.

I flash my NYU School of Medicine ID at the security guard manning the checkpoint for the hospital. I have just a few minutes before morning rounds start. I shove open a set of unmarked double doors on the ground floor, and I’m in the area of the hospital that only the really sick patients see: the back entrance to the ER, the emergency radiology suite, and the service elevators that move patients—including tiny, intubated preemie babies—up to the ICUs and inpatient suites. I know this world well from my medicine months, when I took care of people with heart attacks and diabetic comas. It is quieter back here than in the “F” link. The only people talking are the doctors and nurses; the patients and the transport techs who push their stretchers or wheelchairs are mostly silent.

I turn a corner, just before the hallway of X-ray rooms with their flashing red lights that signal radiation in progress, and look for the sign for CPEP, the Comprehensive Psychiatric Emergency Program.

“It’s just past the station where the cops unload their weapons,” Eileen, one of my co-residents, had told me on the phone the night before.

I see the sign, but from around another corner, I hear tense voices approaching.

“Hold him,” one says. “It’s just over there,” says another.

I stop just in time to avoid the stretcher careening toward the CPEP. One EMS paramedic steers from the back while another stabilizes in front. Two NYPD cops walk on either side. They each have a hand on the body bag wiggling around on the stretcher.

“Hold still,” one of the cops mutters to the bag. He looks across at his partner. “This ain’t gonna be pretty.”

Sounds of protest come from inside the bag—a muffled man’s voice, deep and disturbed. He sounds like he’s crying. The paramedics maneuver the stretcher into the doorway, jostling their passenger as they bump into a desk on the way in. I follow at a safe distance.

“Hold up,” says a hospital police officer, holding his hand in front of my face. “You got to wait.”

“But I work here,” I protest, holding up my ID.

“Don’t matter. You have to stay outside until this gets settled down.” He closes the door in my face.

I try not to panic about being late for rounds on my first day and slump against the wall. I remember the first body bag I ever saw, the one that got me to medical school. I had been visiting Samantha, a close friend from high school and now a second-year medical student. One afternoon, she snuck me into the anatomy lab. The body bag was hidden inside one of many shiny dissection tables laid out in neat rows in the windowless, gymnasium-size room. I felt like I was in a stainless steel graveyard.

“You sure you want to see this?” Samantha asked. “It can be pretty gross if you’re not used to it.”

I wasn’t sure. I gave her a quick nod anyway.

She went over to one of the covered tables and grabbed the handles on top of the hood. She struggled a bit to open it, but eventually the hood broke in two, each side hanging over the edge of the table. On the exposed flat surface lay a black body bag, zipped tight.

“Um . . . can we take a break?” I asked, starting to sweat.

“Sure, oh yeah, of course,” she said as she laughed. “This was really hard for me the first time. Luckily, the students just started so they haven’t dissected much. They’ve probably just cut into his back.”

I turned away and dry-heaved.

“OK, I’m ready,” I said, returning to the carcass and feeling both sick and exhilarated. Samantha slowly unzipped the bag. A waft of formalin and something kind of sweet hit me in the face. The top of a dead man’s head came into view. I closed my eyes for a second and felt a little woozy. He was lying face down on the table. I assume he was a man, but in fact I saw nothing in this posterior view of an older, shriveled body to tell me for sure. His skin was pasty and a little yellow. He didn’t have much hair covering his scalp, and folds of extra skin crowded around the back of his neck.

Samantha unzipped a bit more, and the cadaver’s shoulders and upper back came into view. Flaps of skin from postmortem incisions had been restored as close to their original positions as possible. At some point soon, Samantha told me, the entire backside of this man—all of his muscles, nerves, blood vessels, and bones—would be inspected and dissected. He would then be flipped over, and the same would be done to his front side. Everything stayed inside the body bag, she explained, even the extra fat and skin that would need to be removed to dissect the internal organs. After the dissections were complete, the anatomy professors made sure that each body—likely to be cremated—contained all of the same stuff with which it started.

“Can you believe we get to do this?” Samantha asked.

“No,” I answered quietly. I couldn’t look away. He was not beautiful or warm, but he was inviting. My fingers were itching to pick up the scalpel lying by his side and cut into the flesh. I wanted desperately to understand what was going on inside his body. I wanted to know everything about this dead man.

“We should go,” Samantha said.

She zipped the bag up and closed the steel hood. We scurried out of the room and into the cool, fresh hallway just as the security guard walked by.

“I have never seen anything like that,” I said, awed by the power of that body. Surprising even myself, I whispered, “I think I’m going to medical school.”

Now, seven years later and fifteen minutes after my arrival at the CPEP, the door opens up again and the officer ushers me in.

“Thanks,” I say, quickly walking in and passing the EMS workers, one of whom has an empty body bag over his shoulder. I enter into an open space that has ten chairs bolted to the floor and borders a large windowed panel defining three separate sections of the CPEP. The first section, closest to the entrance and the hospital police officer, is where patients check in. Names and birthdates are confirmed, medical record numbers are assigned, and each new patient is logged into a giant ledger.

The next section is the triage room, which has 270-degree visibility. It’s where a nurse does a preliminary interview and assesses whether a patient is stable enough to sit in the bolted chairs outside, or is so dangerous that he or she has to be locked in behind the door in the third section. Once inside this last area, no patient can get out without a doctor’s order. For these patients, shoelaces and belts are removed to prevent hanging attempts, all property is taken and stored, and any illegal drugs are confiscated and flushed down the toilet.

There is a man handcuffed to a stretcher next to the triage room, asleep. He has a few bruises on his face, and his clothes are torn and dirty. His twisted body and sprawled legs give him the unnatural appearance of someone who has been medically induced into sleep. The cops I saw in the hallway are sitting in the chairs watching him. They look uneasy.

One of the nurses lets me in through a locked door into the triage room, grumbling about how “those interns really need to get their own keys.” I scoot past her and head to where the doctors, medical students, and social workers are already gathered and talking about their patients.

“Sorry,” I whisper as I sit down in the last available folding chair.

“Nice of you to join us,” the attending psychiatrist, Dr. Leon, says to me.

“I was stuck in the hallway for about fifteen minutes,” I say defensively. “The officer wouldn’t let me in.”

“Oh yeah,” says Dr. Leon, softening. “That was the NYPD case. Spitting and fighting. We had to 5 and 2 him.” Although I am new to psychiatry I’ve already heard these numbers on the medicine and neurology wards referring to 5 mg of Haldol and 2 mg of Ativan, a typical cocktail of intramuscular medications given to patients who are aggressively agitated. “Should be awake in a few hours, and then we can get him out of here.”

I am too new and too afraid to ask what I am thinking: What if he needs to be in the hospital? I listen to the rest of the report and notice that Dr. Leon assigns himself the NYPD case; the patient’s name is James. Patients like James get brought in for all kinds of reasons—from requesting Ritalin to trying to hang themselves in the precinct house. The cops know that they could be sued—or fired—if someone in their custody is denied medical or psychiatric care, even if the request is for a pill that the “perp” hasn’t taken for 20 years. Most of the doctors don’t want to assess the NYPD patients; there are so many of them, thousands per year, and only a very small percentage get admitted to the hospital. Dr. Leon is trying to keep his psychiatrists happy by picking up the case. I ask if I can tag along.

Hours later, close to the end of the shift, we go to see James. He is still groggy from the medication but alert enough to answer questions. He’s been charged with second-degree assault, the cops say, because he punched a stranger on the subway. I listen to Dr. Leon ask James a rapid-fire set of standard questions.

“How come the cops brought you to the hospital?”

“Don’t ask me,” James replies gruffly.

“Do you take psych meds?”

“Someone gave me some of those once, but I don’t take ’em. Don’t need ’em.”

“Ever been in the hospital before?”

“Check the record, man. I been here a hundred times before.”

“Are you suicidal?”

“No.”

“Do you want to hurt anyone else?”

“Just those cops who roughed me up.”

“Are you hearing voices?”

James laughs. “Just yours.”

A few other basic questions follow, and Dr. Leon and I return to the doctors’ area. We don’t have James’s medical record to see if he’s been admitted or evaluated here before—this was in the days before computerized medical records.

“This is the form you have to fill out to give to the cops for arraignment,” says Dr. Leon. I have no idea what “arraignment” means, so Dr. Leon gives me a doctor’s explanation: it is the hearing where James sees a judge for the first time and gets an attorney. The form says that James has been “psychiatrically cleared for arraignment” and doesn’t need to be admitted to the hospital.

“How do you decide if he’s OK for arraignment?” I ask.

“It’s a really low threshold—basically, whether he can stand up in front of the judge and whether he can keep from hurting himself or anyone else in the courtroom.”

I am too naive to know that this is just a CPEP definition that evolved because there is no legal definition of “stable for arraignment.” I watch as Dr. Leon hands the paperwork to the cops, tells them James can go, and heads to the next patient on the list. I think about the way James presented—arrested for a stranger attack—and the need for a body bag and heavy tranquilizers to calm him down, the short, clipped answers about medication and hospitalizations. There is more happening with James than the quick assessment revealed. But after he heads out the CPEP door to the waiting NYPD squad car, I never see him again.

2

CAUGHT BETWEEN THE CRACKS

After a few months of facing extreme cases in the CPEP—was this woman going to kill herself if I discharged her? Was the paranoid homeless man going to punch me when I told him that he was staying in the hospital?—I finish that assignment and, after a weekend to recover, head to my next clinical rotation.

On my way to the upstairs inpatient psych...

Table of contents

• Cover
• Author’s Note
• Chapter 1: The Body Bag
• Chapter 2: Caught Between the Cracks
• Chapter 3: Stars Over Bellevue
• Chapter 4: Never What You Expect
• Chapter 5: The Tender and the Troubled
• Chapter 6: Mama Grizzly
• Chapter 7: Pushing the Limit
• Chapter 8: What Doesn’t Break You
• Chapter 9: The Listening Cure
• Chapter 10: A Mother’s Love
• Chapter 11: Even the Stars Can Fall
• Chapter 12: When Darkness Comes
• Chapter 13: Shelter the Broken
• Chapter 14: Unraveling
• Chapter 15: Burnout Strikes
• Chapter 16: Out of the Depths
• Chapter 17: Death and Birth
• Chapter 18: Reunion
• Chapter 19: Back to the Fire
• Chapter 20: Welcome Back
• Chapter 21: Under the Surface
• Chapter 22: Keeping Secrets
• Chapter 23: Compassion Is a Verb
• Chapter 24: When the Bridges Close
• Chapter 25: When the Lights Go Out
• Chapter 26: A Light In the Dark
• Chapter 27: Grace Will Lead
• Chapter 28: On the Island
• Chapter 29: Keeping Promises
• Chapter 30: Difficult Goodbye
• Chapter 31: Sometimes Amazing Things Happen
• Chapter 32: A Story Worth Telling
• Chapter 33: Higher Power
• Chapter 34: Ping-Pong Therapy
• Chapter 35: A Brighter Day
• Chapter 36: Beyond Bellevue
• Epilogue
• Acknowledgments
• About the Author
• Copyright